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Laser prostate surgery


Holmium Laser Enucleation of the Prostate


Holmium Laser Enucleation of the Prostate, otherwise known as HoLEP, is a surgical technique available for the treatment of urinary symptoms due to benign enlargement of the prostate (BPH). It is the only laser technique recommended by NICE (the National Institute for Health and Clinical Excellence) for the treatment of BPH in the UK and is recommended for men with prostates of any size.


HoLEP was developed by 2 New Zealand Urologists, Peter Gilling and Mark Fraundorfer, in the 1990’s. There are a large number of published clinical trials that support it as a new “Gold Standard” for treating BPH. HoLEP has been performed at Addenbrookes Hospital since Mr Aho (who trained with Messrs Gilling and Fraundorfer) was appointed as a consultant urologist in 2004. We are the most experienced HoLEP centre in the UK having performed more than 1000 HoLEP procedures. Addenbrookes is recognised as a centre of excellence for HoLEP. Urology teams from the UK and abroad attend our training meetings to learn how to set up and run a successful HoLEP service.

Advantages of HoLEP

HoLEP was developed to improve the effectiveness, safety and durability of surgery for BPH. The main advantages of HoLEP over Transurethral Resection of the Prostate (TURP) which has been in use for the past 50 years include:

  • More tissue removed
  • Suitable for men with prostates of any size
  • Can be used in men who have bleeding disorders or are on blood thinners (eg. Aspirin, clopidogrel and warfarin)
Prostate anatomy

Where is the Prostate and What Does it Do?

Unless affected by BPH the prostate is a walnut sized gland. It is only found in men and is a solid organ with a hollow channel running through it’s centre that is situated between the bladder and the urethra tube. Urine travels from the bladder through the channel in the prostate and into the urethra when urinating. The prostate is tiny in childhood, grows during puberty and is the only organ that continues to grow throughout life. It is this growth later in life that can cause urinary problems.
The prostate produces some of the fluid in semen. Men can live a perfectly healthy life if part or even all of the prostate is removed surgically.

Why are urinary symptoms (waterworks problems) important in men?

Urinary symptoms are the most common and bothersome symptoms affecting men beyond middle age. They may indicate a serious underlying problem and are therefore important to inform your doctor about. There are a number of potential causes for urinary symptoms in men but by far the most common is Benign Prostatic Hyperplasia (BPH).

What symptoms can be caused by BPH?

  • BPH leads to a physical growth of the prostate which may compress the prostate channel causing the urinary stream to slow, an intermittent flow (stopping and starting during urination), and straining to begin urination
  • After a while the bladder tries to compensate for the prostate blockage by becoming muscular and more powerful. This leads to the bladder becoming “unstable” with the bladder muscle contracting more frequently and forcefully than previously. This can increase the number of times you pass urine day and night and cause urgency (a sensation of having to rush to the toilet to pass urine at times).
  • Sometimes as the prostate grows it can cause blood to appear in the urine
  • If the prostate blockage prevents the bladder from emptying properly, there is an increased risk of developing urinary infections, and forming bladder stones in the pool of stagnant urine in the bladder. Rarely, if the bladder is always full, back pressure can be transmitted up to the kidneys and this can cause kidney failure.
  • In men who have a degree of prostate obstruction there may be a sudden inability to pass urine. This leads to the very painful complication of urinary retention which is treated initially by placement of a urethral catheter. In most men who experience painful urinary retention it is appropriate to consider surgery to allow successful removal of the catheter and to prevent retention from occurring again in future.

What common tests are performed to identify urinary symptoms due to BPH?

The main purpose of tests done to investigate men with urinary symptoms are to:

  1. Rule out cancer.
    This is done by testing a urine sample, performing a blood test (Prostate Specific Antigen- PSA), and examining the prostate by rectal examination.
  2. Look for evidence of prostate obstruction.
    This is done by measuring a urine flow test and checking how well the bladder has emptied by scanning it soon after passing urine.

What are the treatment options for urinary symptoms due to BPH?

  1. Lifestyle changes
    For men with minimal urinary symptoms the impact of these symptoms on their lives can be minimised by decreasing alcohol and caffeine intake and reducing fluid intake in the evening
  2. Medical treatment
    Two types of tablets are available for treating BPH:
  • Alpha blockers relax the muscle in the prostate and bladder neck to help widen the prostate channel when urinating.
  • 5-alpha reductase inhibitors shrink the prostate
  • Some plant extracts such as saw palmetto are also favoured by some men and can improve urinary symptoms
  1. Surgical treatment
    For men whose urinary symptoms are a nuisance/impair quality of life, and who either :
  • Don’t like to be on longterm medication
  • Have side effects from the medication
  • Don’t respond to the medication
  • Are bleeding from their prostate repeatedly
  • Have urinary infections due to their prostate
  • Have bladder stones
  • Have urinary retention
  • Have kidney failure due to their prostate
  • Surgery (HoLEP or TURP) may be an appropriate treatment.

BPH in numbers

  • Urinary symptoms due to BPH affect 3.2 million men in the UK.
  • Only 400,000 receive treatment despite effective treatments being readily available